Accuracy comparison of various quantitative [99mTc]Tc-DPD SPECT/CT reconstruction techniques in patients with symptomatic hip and knee joint prostheses

Martin Braun; Michal Cachovan; Felix Kaul; Federico Caobelli; Markus Bäumer; A Hans Vija; Geert Pagenstert; Damian Wild; Martin Kretzschmar

doi:10.1186/s13550-021-00794-7

Accuracy comparison of various quantitative [^99mTc]Tc-DPD SPECT/CT reconstruction techniques in patients with symptomatic hip and knee joint prostheses

EJNMMI Res. 2021 Jun 14;11(1):60. doi: 10.1186/s13550-021-00794-7.

Authors

Affiliations

¹ Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
² Siemens Healthcare GmbH, Molecular Imaging, Forchheim, Germany.
³ Siemens Medical Solutions USA, Inc., Molecular Imaging, Hoffman Estates, USA.
⁴ Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland.
⁵ Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland. martin.kretzschmar@bilddiagnostik.ch.

^# Contributed equally.

Abstract

Background: There is a need for better diagnostic tools that identify loose total hip and knee arthroplasties. Here, we present the accuracy of different ^99mTc-dicarboxypropandiphosphate ([^99mTc]Tc-DPD) SPECT/CT quantification tools for the detection of loose prostheses in patients with painful hip and knee arthroplasties.

Methods: Quantitative reconstruction of mineral phase SPECT data was performed using Siemens xSPECT-Quant and xSPECT-Bone, with and without metal artefact reduction (iMAR) of CT-data. Quantitative data (SUVmax values) were compared to intraoperative diagnosis or clinical outcome after at least 1 year as standard of comparison. Cut-off values and accuracies were calculated using receiver operator characteristics. Accuracy of uptake quantification was compared to the accuracy of visual SPECT/CT readings, blinded for the quantitative data and clinical outcome.

Results: In this prospective study, 30 consecutive patients with 33 symptomatic hip and knee prostheses underwent [^99mTc]Tc-DPD SPECT/CT. Ten arthroplasties were diagnosed loose and 23 stable. Mean-SUVmax was significantly higher around loose prostheses compared to stable prostheses, regardless of the quantification method (P = 0.0025-0.0001). Quantification with xSPECT-Bone-iMAR showed the highest accuracy (93.9% [95% CI 79.6-100%]) which was significantly higher compared to xSPECT-Quant-iMAR (81.8% [67.5-96.1%], P = 0.04) and xSPECT-Quant without iMAR (77.4% [62.4-92.4%], P = 0.02). Accuracies of clinical reading were non-significantly lower compared to quantitative measures (84.8% [70.6-99.1%] (senior) and 81.5% [67.5-96.1%] (trainee)).

Conclusion: Quantification with [^99mTc]Tc-DPD xSPECT-Bone-iMAR discriminates best between loose and stable prostheses of all evaluated methods. The overall high accuracy of different quantitative measures underlines the potential of [^99mTc]Tc-DPD-quantification as a biomarker and demands further prospective evaluation in a larger number of prosthesis.

Keywords: Arthroplasty; Aseptic loosening; Quantification; SPECT/CT.